Fourth-year doctoral student Ilona Nemeth remembers working with a client who, in the past seven months, had lost his source of income while in the process of finding his own apartment.
The client’s stipend had run out, and for unknown reasons, his Social Security income kept getting denied.
“He was feeling a lot of pressure while he was appealing the decision,” said Nemeth, a student in Doctor of Psychology in Clinical Psychology program. “Meanwhile, he was going through the stresses of finding his own place, on top of dealing with symptoms of post-traumatic stress disorder, anxiety, and panic attacks,”
She met the client at her Adler Community Health Service (ACHS) externship at Thresholds, one of the oldest and largest providers of recovery services for persons with mental illnesses and substance use conditions in Illinois.
“He was living in a nursing facility, and I was working with him in coming to terms with the fact that he was ready to live on his own,” Nemeth said.
Ilona Nemeth
When the good news arrived that the client — referred to as “members” at Thresholds — finally received his Social Security income and was able to move into his own apartment, it became a highlight in Nemeth’s externship experience.
“This client was afraid of feeling lonely living on his own, but he did a lot of work on himself, made so much progress, and is now in a really good place,” Nemeth said. “It was exciting to be there for him as he was navigating a number of obstacles.”
“And I didn’t do all of that on my own,” she added. “It’s what I’ve love about my experience at Thresholds. Providing mental health support to clients with serious mental illness or substance use conditions is only one part of a bigger team effort.”
Pushing the envelope
Thresholds offers 30 innovative programs at more than 75 locations throughout Illinois. Services include assertive outreach, case management, housing, employment, education, psychiatry, primary care, substance use treatment, and research.
Through its community-based engagement, support, and advocacy, Thresholds helps people living with mental health and substance use conditions find homes, better physical and mental health, and experience lives with greater autonomy and happiness.
“The organization is such a unique placement for our students because Thresholds has been pushing the envelope in providing the best services available,” said Jason Grebasch, ACHS clinical faculty. “For our trainees interested in working in community mental health, they are exposed to working with different clients who have different cultures and different needs.”
According to Thresholds’ 2023 annual report, at the time of initial service, 90% of Thresholds clients are unemployed and are living well below the National Poverty Level. About half have co-occurring substance use conditions, and most have at least one advanced physical health problems, such as diabetes and heart disease.
In 2023, Thresholds served 8,360 clients. Of those 84% were linked to a psychiatrist and 85% were linked to a primary care provider. Of the total clients, 19% were diagnosed with major depression disorder, 18% with bipolar disorder, and 34% with schizophrenia spectrum disorder. The services provided at Thresholds has resulted in 97% of its clients showing confidence in their recovery.
“The team at Thresholds can put in a referral for a client to get a dedicated counselor or therapist who only wears that one hat and focus on helping them with their mental health,” said Derek Harris, internships and integrated care director at Thresholds. “For three of our sites, that’s really where the ACHS students come into play.”
Part of a team
Since 2015, ACHS interns and externs, like Nemeth, have provided mental health support to clients — many coming from vastly different backgrounds with vastly unique needs — at Thresholds.
Derek Harris
Currently, about a dozen ACHS interns and externs are part of Threshold’s dedicated teams by providing mental health support at three sites: 63rd and Woodlawn, 47th and Halsted, and 4423 N. Ravenswood Ave. ACHS interns and externs provide mainly individual therapy, along with group therapy and psychological testing.
However, ACHS students aren’t the only ones Thresholds clients work with. Each client is assigned a dedicated team, which sets specific short- and long-term goals and objectives, based on the client’s needs, desires, and level of self-sufficiency.
“And I couldn’t stress enough how beneficial their work has been,” Harris said. “About five or six staff members are dedicated to each of our clients. But students from Adler and ACHS really helps with a key piece, which is to mentally assess and prepare our clients in living self-sufficient lives.”
For Nemeth’s client, it was support for mental health, along with securing housing and finances.
“The team from Thresholds helped him with the practical matters of coordinating a move, including making sure he was able to receive his Social Security income and had transportation to apartment showings. When he was ready to move out, they helped him pick out groceries and moving in his furniture,” she said. “We were able to support him from all sides.”
Members of the ACHS and Thresholds teams attend the “Building Community for Social Justice” event held on May 9 at the Chicago Campus. Since 2015, ACHS interns and externs have provided mental health support to clients — many coming from vastly different backgrounds with vastly unique needs — at Thresholds.
Wearing one hat
For Chika Ofodu, a Palo Alto, California Ph.D. student conducting her predoctoral internship at ACHS, working at Thresholds is not her first experience in a community mental health setting.
Chika Ofodu
“But this is the first place where I’ve only needed to really focus on my client’s mental health,” she said.
In previous experiences, Ofodu said she has often worn multiple hats to help a client.
“I wasn’t just the counselor, I was a person’s case manager or social worker, I was looking for housing,” she said. “Sometimes, I’ve had to help them navigate insurance policies and legal documents. I’ve had different cases in previous organizations where I thought to myself, ‘This goes way beyond my scope.’”
At Thresholds, the interns can focus on providing mental health services, while the larger team can take care of the client’s other needs.
Earlier in January, Ofodu was connected with a client who had walked into Threshold’s site at 4423 N. Ravenswood Ave. and entered the “Living Room” — a type of crisis center for folks who are often in an immediate crisis and need to be connected to services.
“One client was referred to me because they had recently experienced homelessness and didn’t have insurance for their medical needs,” Ofodu said. “They were feeling lost.”
But within a few weeks of working with this client, Ofodu and the support team at Thresholds were able to connect the client to services, including signing up for Medicaid.
“As a trainee, I don’t feel as overwhelmed because I don’t have to try to go beyond my expertise and knowledge. That’s what I’ve enjoyed about Thresholds,” she said. “When the Thresholds team found the client housing, I just remember how much this member lit up. I watched this member evolve from feeling lost to becoming resourceful and feeling more confident.”
That unique approach to community mental health has been so beneficial for all ACHS interns.
“Our students get to focus on providing therapy and testing,” Grebasch said.
“And that approach has really helped me see the depth and breadth of working with people experiencing serious mental illness,” Ofodu added. “And of course, this experience has improved my own clinical skills and knowledge of systems of care.”